One of the most common reasons a child comes to see me is
that his behavior is out of control. Often they are easily frustrated, angry,
or irritable. Often things are getting broken, or people are getting hurt, and
usually there is lots of yelling.† When
parents look up information about this, it seems that the child could have symptoms
of many illnesses, but right now the main question is whether or not they have
bipolar illness. agoogle
search of bipolar and temper tantrums in children yields 250,000 results!

You get the best results if you have the best diagnosis.
Here is how we separate out the causes of rages and tantrums.

Questions to ask

How many clear signs of bipolar disorder are there?

Classic Bipolar Disorder

Children who have all the signs of bipolar disorder, which
means mania, (See bipolar handout)† and have it for at least a week. I
have never seen a child under 10 with this. I see many 13-16 year olds who have
this. This is quite severe, and usually leads to further bipolar illness as
adults.

Children who have some signs of bipolar disorder

Right
now in 2011, this is called severe mood dysregulation
or SMD.† These children are almost always
irritable, and never have a really high or elevated mood.† They have huge anger outbursts with at least
3 signs of mania plus distractibility. These children usually end up having
depression and anxiety when they are older, and even though they do have a few
manic symptoms, they donít turn out to have bipolar disorder. (1)

Are there
other aspects of their lives that are out of control?

Children
who canít seem to regulate anything.

These
children canít control their emotions. Little things make them very excited,
very angry, very frustrated, and very mad. All of their emotions, good or bad,
seem extreme. Besides this, they have signs of ADHD and canít sit still, are
hyperactive, and do things without thinking. Their thoughts are also not under
control and they immediately do everything they think of, never consider the
risk to themselves or others, and never know why they did anything.† This profile of dysregulation
of moods, behavior and thinking doesnít really have a good name right now
except dysregulation profile. These children end up
with drug abuse, ADHD, depression, personality disorders, and anxiety, but not
bipolar disorder.

Children who were horribly neglected, abused, or traumatized††††††††††††††††††††

A
combination of different disorders of neglect and trauma can cause horrible
tantrums and moodiness, but the cause is totally different from bipolar
illness. These are described in the youtube videos on
attachment, PTSD, and dissociation.

Children
with Autism

When
autistic children get overwhelmed, they can decompensate in a way that looks
like bipolar illness or psychosis.

Fetal
Alcohol Syndrome

Exposure
to alcohol during pregnancy can lead to a host of problems that cause temper
tantrums, out of control behavior, no inhibitions, and aggression

Children with conduct disorder

What seems to be out of control isnít always. Anger
outbursts can be very useful for controlling others and getting your way.

Drugs and alcohol

A host of other rarer problems

A combination of the above.

Most of the children I see donít have one cause. Here are
some sadly typical examples.

Out of control from:

Drugs, Conduct Disorder, and being sexually abused

Autism and abuse related disorders

Fetal Alcohol Syndrome, Neglect, Abuse, ADHD

Full Bipolar Disorder, Drugs

Treatment

No matter what the cause, out of control kids need treatment
as soon as possible. The treatment usually requires the right medication, the
right parenting techniques, changes in the environment, and counseling. The
medical treatment will depend on the diagnosis, which is why I am seeing the
child!

In
summary,† when a child is out of control
and raging they look pretty much the same no matter what the cause is. †I have seen many home videos of children who
are out of control, and they look remarkably the same no matter what the cause
of the outbursts. To figure out the cause, you need to carefully look at the
childís history, medical problems, and genetics. Once you know the cause, then
the treatment should be easier to figure out.